Provider Demographics
NPI:1376507236
Name:PODBROS, LINDA ZOE (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ZOE
Last Name:PODBROS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:84 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2133
Mailing Address - Country:US
Mailing Address - Phone:781-784-1739
Mailing Address - Fax:781-784-9488
Practice Address - Street 1:84 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2133
Practice Address - Country:US
Practice Address - Phone:781-784-1739
Practice Address - Fax:781-784-9488
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3416103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAVC6000029068OtherCOMMONWEALTH OF MA VENDOR
MAW03577OtherBLUE CROSS-BLUE SHIELD
MA0514306Medicaid
MA706592OtherTUFTS HEALTH PLAN
MA000943OtherHARVARD-PILGRIM
MA5646184OtherAETNA
MA0514306Medicaid